Mental Health Care Law in Saudi Arabia

The Mental Health Care Law in the Kingdom of Saudi Arabia is a regulatory framework governing mental health care in the Kingdom. Its primary focus is to protect the rights of individuals with mental illnesses while providing appropriate treatment mechanisms. It establishes core principles aimed at safeguarding the rights and dignity of patients, their families, and society. Additionally, it outlines methods for treating individuals within mental health facilities and seeks to organize and improve the quality of care available to those in need of mental health services.

The Mental Health Care Law was issued on July 17, 2014, and comprises thirty articles. Its Implementing Regulations were issued in 2016 and amended by the Ministry of Health in 2021.

The Mental Health Care Law aims to regulate and promote mental health care services required for psychiatric patients; protect the rights and dignity of psychiatric patients, their families, and the community; and develop a mechanism for dealing with and treating psychiatric patients at mental health treatment facilities.

Under the Mental Health Care Law, a psychiatric patient has several rights, including receiving due care in a safe and clean environment and receiving treatment in accordance with medical commonly accepted standards. Other rights include respecting his individual rights in a healthy and humane environment that preserves his dignity and meets his medical needs; informing him, prior to commencement of treatment, of the diagnosis and progress of the treatment plan; and informing him, prior to consenting to treatment, of the expected response, benefits, risks, and possible side effects as well as available treatment alternatives and possible amendments thereto. If there is a need to transfer a patient within or outside a mental health treatment facility, said patient or his guardian, if the patient is incapable of consent, has the right to be informed of the transfer and reasons therefor. Moreover, rights include not subjecting him to any experimental treatment, even if such treatment is licensed or included in medical research or an experiment, without his informed written consent if capable of consent, his guardian’s written consent if incapable of consent, or the authorization of the local supervisory board for mental health care if he has no guardian. Among the rights is refraining from administering any type of treatment to him without his consent, or the consent of his guardian if incapable of determining his need for treatment. If the patient is incapable of determining his need for treatment and has no guardian or the guardian cannot be reached, the necessary treatment may be administered subject to the approval of two psychiatrists and notification of the local supervisory board for mental health care.

Article Three of the Mental Health Care Law stipulates the formation of the General Supervisory Board for Mental Health Care to propose ideas for the development and improvement of mental health care and submit the same to the Saudi Health Council; oversee the implementation of the provisions of this law, ensure compliance with it by mental health treatment facilities in all sectors and monitor said facilities, whether directly or through committees set up for the purpose of monitoring all mental health treatment facilities and psychiatric patients hospitalized at such facilities, and examine and verify records and reports and take necessary action to rectify any violations; set up local supervisory boards for mental health care in provinces and governorates as necessary; supervise and monitor the work of local supervisory boards for mental health care; examine the affairs of psychiatric patients and the reports submitted to it by local supervisory boards for mental health care; consider grievances filed by patients, their families, or their representatives upon exhausting all grievance procedures before the local supervisory board for mental health care; set up committees from among board members or other experts or specialists to review involuntary admission decisions; and any other responsibilities as the Council of Ministers may determine.

Under Article Six of the law, a board named the local supervisory board for mental health care is established to oversee the implementation of the provisions of this law; ensure compliance with it by mental health treatment facilities in all sectors falling within its local jurisdiction; monitor mental health treatment facilities, whether directly or through committees set up for the purpose of monitoring all mental health treatment facilities and psychiatric patients hospitalized in all departments thereof; examine and verify the accuracy of records and reports; take necessary action to rectify any violations; and submit periodic biannual reports to the General Supervisory Board for Mental Health Care.

The council also considers grievances filed by patients, their families, or their representatives in accordance with the provisions of this law; approves the administration of unorthodox treatments to involuntarily admitted patients upon the request of the attending physician, providing justification and anticipated results, if the patient is incapable of giving consent or his guardian cannot be reached; reviews reports provided by mental health treatment facilities relating to involuntary admission and treatment cases; revoke, at the board’s discretion, involuntary admission decisions issued by mental health treatment facilities and assess the condition of patients involuntarily admitted to mental health treatment facilities for periods exceeding six months; assign, when needed, an external consultant psychiatrist to assess a patient’s mental state within two weeks from the date of filing the grievance, for the board to decide on the grievance; nominates caretakers for involuntarily admitted patients who lack legal capacity and have no guardians, until they regain legal capacity, and file said nomination with the competent court for approval; receives notifications provided by mental health treatment facilities concerning involuntary admission cases, monitors said cases to assess their need for continued hospitalization, and ensure that their rights under this law are protected; and attend to any other duty assigned thereto by the General Supervisory Board for Mental Health Care in accordance with the provisions of this Law.

According to Article Ten, admission to a mental health treatment facility may be voluntary upon the written consent of a psychiatric patient, if capable of giving consent, or his guardian. A patient may leave if he so wishes, unless involuntary admission conditions apply to him. On the other hand, no person may be involuntarily admitted to a mental health treatment facility unless all of the following conditions are met: 1. There is clear evidence, at the time of examination, that the person in question is suffering from a severe mental disorder, the symptoms of which pose actual or potential threat to the patient or others. 2. Admission of a psychiatric patient to the mental health treatment facility is necessary for the patient’s recovery, improvement, or control of the deterioration of his condition. 3. Two psychiatrists sign a form attesting to the satisfaction of the conditions set forth in paragraphs (1) and (2) of this article, stating the health condition and justifications for involuntary admission.

As per Article Seventeen, involuntary therapeutic care apply to persons suffering from mental disorders and are in need of therapeutic care, pursuant to a decision approved by two psychiatrists stating the justifications for imposing involuntary therapeutic care and the necessary treatment plan.

Involuntary therapeutic care necessitated by the health condition of a psychiatric patient must, without the consent or admission of said patient, be administered at outpatient clinics or his place of residence, and the local supervisory board for mental health care must be notified of the same within forty-eight business hours from the time the decision to administer involuntary therapeutic care is made.

If a psychiatric patient fails to follow the involuntary therapeutic care program, the mental health treatment facility may request the local supervisory board for mental health care to take necessary action to administer involuntary therapeutic care to the patient. In order to conduct involuntary therapeutic care in the place of residence of the psychiatric patient under the supervision of a specialist psychiatrist, the psychiatric patient or his guardian, as the case may be, must comply with the instructions of the treatment team.

If a psychiatric patient declines to receive involuntary therapeutic care, his case is reviewed by two psychiatrists and if the conditions stipulated in Article Thirteen of this law apply. Said psychiatrists submit a detailed signed report to involuntarily admit said patient to the mental health treatment facility and the local supervisory board for mental health care is notified of the same.

The regulations specify the procedures for requests made by psychiatric patients receiving involuntary therapeutic care to transfer to another facility. Involuntary therapeutic care is for a maximum period of 180 days. Such period may be extended or renewed as required by the condition of the psychiatric patient. The patient, his guardian, or attorney-in-fact have the right, in accordance with the provisions of this law, to object at any time to an involuntary therapeutic care decision before the local supervisory board for mental health care or the General Supervisory Board for Mental Health Care, as the case may be.

The psychiatric patient, his guardian, or attorney-in-fact may request in writing the termination of involuntary therapeutic care. The mental health treatment facility must respond within seven days from the date of receipt of such request. If the mental health treatment facility decides to continue treatment, the psychiatric patient, his guardian, or attorney-in-fact may appeal before the local supervisory board for mental health care.

Involuntary therapeutic care may be terminated in the following cases: 1. If the attending psychiatrist so decides, provided that a report on the condition of the patient and justifications for termination is submitted to the local supervisory board for mental health care; 2. If the stipulated period expires without renewal or extension; 3. If so determined by the local supervisory board for mental health care.

According to Article Twenty-Five, any person violating the provisions of the Mental Health Care Law is subject to any of the following penalties:

Imprisonment for a period not exceeding two years and a fine not exceeding SAR200,000, or either penalty, for any practitioner at a mental health treatment facility who intentionally provides in his report false statements regarding the mental condition of any person for the purpose of admitting said person to or releasing him from hospital, as well as any person who detains or causes the detention of any person as a mental patient in places and conditions other than those provided for under this law. The judge may increase the imprisonment beyond the maximum term and not exceeding the period for which the victim had been detained, if the victim is proven to have been detained for a period exceeding two years.

Imprisonment for a period not exceeding one year and a fine not exceeding SAR25,000, or either penalty, for any person assigned to guard, treat, or nurse a psychiatric patient and abuses or neglects said patient in a manner that would inflict pain or harm thereon, or violates the provisions of Article Nine, Clause (Four) of this Law. If abuse results in the illness or physical injury of the psychiatric patient, the penalty is imprisonment for a period not exceeding three years.

Imprisonment for a period not exceeding six months and a fine not exceeding SAR50,000, or either penalty, for any person who facilitates or assists with the flight of an involuntarily admitted patient; refuses to provide information needed by the supervisory boards or their inspectors to perform their duties; obstructs authorized inspection carried out by the supervisory boards in accordance with this law; or falsely and in bad faith informs the competent entity that a certain person suffers from mental illness.

Imprisonment for a period not exceeding three months and a fine not exceeding SAR50,000, or either penalty, for any person who discloses confidential information of a psychiatric patient contrary to the provisions of this law.

Imposition of the penalties provided for in this law does not preclude victims from initiating disciplinary or civil legal action.